From the Guidelines
Pregnancy can worsen tricuspid regurgitation due to significant cardiovascular changes, and women with severe regurgitation should be monitored in a tertiary care center with a dedicated Heart Valve Team. During pregnancy, blood volume increases by 30-50%, cardiac output rises by 30-50%, and heart rate increases by 10-20 beats per minute, placing additional strain on the right heart and potentially exacerbating pre-existing tricuspid regurgitation or causing new regurgitation in women with previously normal valves 1. The increased blood volume leads to right ventricular dilation, which can distort the tricuspid annulus and prevent proper valve closure. Additionally, the physiologic anemia of pregnancy and increased metabolic demands further stress the cardiovascular system. Women with moderate to severe tricuspid regurgitation before pregnancy should be closely monitored by both an obstetrician and cardiologist throughout pregnancy, with regular echocardiograms to assess valve function and right ventricular performance 1. Symptoms like increased fatigue, shortness of breath, peripheral edema, or palpitations may indicate worsening regurgitation. Management typically focuses on controlling symptoms through activity modification, careful fluid management, and sometimes diuretics if significant fluid retention occurs. Most women with mild to moderate tricuspid regurgitation tolerate pregnancy well, but those with severe regurgitation or right ventricular dysfunction may experience complications including heart failure, arrhythmias, or preterm delivery 1.
Some key points to consider in the management of tricuspid regurgitation during pregnancy include:
- Close monitoring by a multidisciplinary team, including cardiologists, obstetricians, and anesthesiologists
- Regular echocardiograms to assess valve function and right ventricular performance
- Controlling symptoms through activity modification, careful fluid management, and sometimes diuretics
- Discussion of the risks and benefits of pregnancy and delivery with the patient, including the potential need for interventions before pregnancy
- Arrangements for the patient to be monitored in a tertiary care center with a dedicated Heart Valve Team if severe regurgitation is present.
It is essential to prioritize the management of tricuspid regurgitation during pregnancy to minimize the risk of complications and ensure the best possible outcomes for both the mother and the fetus.
From the Research
Effects of Pregnancy on Tricuspid Regurgitation
- Tricuspid regurgitation can be aggravated during pregnancy due to physiologic hemodynamic changes, including higher circulating volume, heart rate, and cardiac index, as well as stress during labor 2.
- The presence of valvular heart disease, such as tricuspid regurgitation, increases the risk of maternal and fetal/newborn adverse events 2, 3.
- A study found that adverse cardiac events occurred in 13% of pregnancies in women with moderate or severe regurgitant valve lesions, including 15% with tricuspid regurgitation 3.
- Determinants of cardiac events in women with tricuspid regurgitation during pregnancy include left ventricular systolic dysfunction, pulmonary hypertension, and cardiac events before pregnancy 3.
- Mild tricuspid regurgitation is a benign finding in fetuses and can be detected in early pregnancy, but often resolves by the mid-trimester 4.
Management and Outcomes
- Early diagnosis, risk assessment, and specific management are crucial for women with tricuspid regurgitation during pregnancy 2.
- A case study reported successful management of a patient with severe pulmonary hypertension, moderate tricuspid regurgitation, and moderate right ventricular dysfunction presenting for a dilation and curettage using a slowly titrated lumbar epidural and invasive blood pressure monitoring 5.
- Women with tricuspid regurgitation and other valvular regurgitation lesions are at higher risk for cardiac complications during pregnancy, but maternal mortality is rare 3.